1. Field of the Invention
The present invention relates to systems and processes for supporting the delivery of health care to individuals. More particularly, the present invention relates to devices and methods dedicated to effectuating the provision and management of a cooperative health care system in connection with an integrated cooperative group of entities. The present invention is concerned with a new paradigm of systems concerned with, and supported by, communications and computer networks and methods of using the same for providing medically oriented services while coordinating the various functions associated therewith.
2. Description of the Related Art
Historically, the dispensation of health care has generally occurred in a fragmented manner. Typically, individuals obtain medical services from health care providers; i.e., physicians, pharmacies, hospitals, or the like as needed. Increasingly over the past sixty years, these services have received coverage by some form of third party payor, such as the employer, the government, or an insurance mechanism, with the balance payment remaining the responsibility of the patient. Sometimes the patient pays directly for the services, and sometimes payment is effected by use of credit through a credit card company or the like. At other times, claims are submitted by the patient or by the provider to an insurance company who then pays the provider, patient, or both, as appropriate. There are many inefficiencies and inequalities inherent in this disjointed health care system and procedure.
Some business organizations have sprung up as health maintenance organizations which have prearranged service availability with particular health care providers where access, availability and methodology of treatment modalities are directly related to the structure and the payment mechanism inherent in vertically oriented organizations and related systems. Such arrangements tend to restrict the ability of the patient to select someone better known, or more desirable as a particular health care provider, to handle the particular problem.
Some prior art medical applications have employed computer systems and communications networks for various purposes. For example, U.S. Pat. No. 5,065,315 by Garcia employs a computer-based system for collecting patient data and producing time oriented task lists within a given hospital facility. In U.S. Pat. No. 4,491,725 by Pritchard, medical insurance coverage verification is initiated from a patient identifying card so as to access a central database through a data processing network.
Still other data processing systems have utilized computer programs, computers and data processing communication networks to interconnect a plurality of care providers, banks and insurance companies through a central computer to allow determinations of coverage and payments for patients, such as in U.S. Pat. No. 4,858,121 by Barber et al, U.S. Pat. No. 4,916,611 by Doyle et al, and U.S. Pat. No. 5,070,452 by Doyle et al. Such prior art arrangements have not provided the systems and methods for effectuating a fully integrated and cooperative system for dispensing and managing health care.